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A Novel Approach of Periodontal Osseous Wall Piezosplitting and Sequential Bone Expansion in Management of Localized Intra-Bony Defects with Wide Angulation—A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11060791. [PMID: 36981448 PMCID: PMC10047935 DOI: 10.3390/healthcare11060791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
Piezoelectric surgical instruments with various mini-sized tips and cutting technology offer a precise and thin cutting line that could allow the wider use of periodontal osseous wall swaging. This randomized controlled trial was designed to investigate the use of a minimally invasive piezo knife to harvest vascularized interseptal bone pedicles in treating intra-bony defects. Sixteen non-smoking patients (mean age 39.6 ± 3.9) with severe chronic periodontitis were randomly assigned into one of two groups (N = 8). The Group 1 (control) patients were treated by bone substitute grafting of the intra-bony defect, whereas the Group 2 patients were treated by intra-bony defect osseous wall swaging (OWS) combined with xenograft filling of the space created by bone tilting. In both groups, the root surfaces were treated with a neutral 24% EDTA gel followed by saline irrigation. Clinical and radiographic measurements were obtained at baseline and 6 months after surgery. The sites treated with osseous wall swaging showed a statistically significant probing-depth reduction and increase in clinical attachment compared with those of the Group 1 patients. The defect base level was significantly reduced for the OWS group compared to that of the Group 1 control. By contrast, the crestal bone level was significantly higher in the OWS group compared to Group 1. The crestal interseptal bone width was significantly higher in Group 2 at 6 months compared to the baseline value and to that of Group 1 (<0.001). The osseous wall swaging effectively improved the clinical hard- and soft-tissue parameters. The use of mini inserts piezo-cutting, sequential bone expanders for osseous wall redirection, and root surface EDTA etching appears to be a reliable approach that could allow the use of OWS at any interproximal dimension.
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Effect of Endodontic Irrigating Solutions on Radicular Dentine Structure and Matrix Metalloproteinases-A Comprehensive Review. Dent J (Basel) 2022; 10:dj10120219. [PMID: 36547035 PMCID: PMC9776432 DOI: 10.3390/dj10120219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Irrigating solutions play an important role in the eradication of intracanal microbes and debris dissolution during endodontic treatment. Different combinations of solutions and protocols have been advocated, with sodium hypochlorite (NaOCl), ethylenediamine tetra acetic acid (EDTA), and chlorhexidine (CHX) remaining the most widely used ones by many clinicians. Although these solutions provide efficient inorganic dissolution and antimicrobial capacity, their use has also been reported to cause undesired effects on root dentin composition and mechanical and biomechanical properties, such as microhardness, surface roughness, bond strength, and matrix metalloproteinase (MMP) activity. Several corroborating studies attribute these changes in mechanical properties of dentine to the use of irrigating solutions, and there are limited reports on how the solutions affect the expression of MMPs, which may be a correlating link to understanding the role of these enzymes in dentin collagen and changes in the mechanical properties of dentin. Hence, using the basis of several studies from the literature, the objective is to comprehensively review the influence of individual and combined irrigating solutions on root dentine structure and the activity of the MMPs.
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Gamal AY, Abdel-Ghaffar KA, Zouair MG, Salama MH, El Destawy MT. Dimensional evaluation of blood clot gap distances within intrabony defects following grafting and EDTA root surface treatment-experimental study in dogs. J Periodontol 2019. [PMID: 29536543 DOI: 10.1002/jper.17-0361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Because it is important to establish and maintain a firm blood clot to the surrounding tissues within the intrabony lesion; we have to investigate the potentials of different materials in resisting clot retraction that disrupt clot adhesion to the root surface. This study was designed to measure the gap distance created by clot retraction within the defect following intrabony defects grafting with and without root surface EDTA etching. METHODS Eight mongrel dogs with surgically created acute-chronic bilateral mandibular interproximal intrabony defects in the premolar-molar areas were enrolled in this study (total 8 defects per dog). Intrabony defects were divided into four groups, the first group (OFD): control open flap debridement, the second group, (EDTA treated defects) in which debridement of the defects was followed by two minute root surface etching with a neutral 24% EDTA gel followed by two minute copious saline irrigation, the third group (only grafted defects): defects received closely packed β-TCP of a particle size ranged from 150 to 500 mm, and the fourth group, (Graft + EDTA treated defects): defects were etched for 2 minutes with a neutral 24% EDTA gel and saline irrigation followed by intrabony defect fill of β-TCP. Twenty four hours post treatment, animal euthanasia was carried out for histomorphometric analysis of the tooth and root side gap distances. RESULTS EDTA treated group and EDTA + graft group showed statistically significant lower degree of clot shrinkage compared to both the control and only grafted group. Clot shrinkage in EDTA treated group showed no significant difference from that of the EDTA + graft group (p = 0.197). OFD and only grafted groups were found to show statistically higher clot retraction percnetage compared to both EDTA and EDTA+graft groups. CONCLUSION following intrabony defect debridement, blood clot undergoes clot retraction creating a micro gap with the root surface. EDTA root surface etching before graft application into the defect area significantly reduced the amount of gap distance.
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Affiliation(s)
- Ahmed Y Gamal
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - Khaled A Abdel-Ghaffar
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed G Zouair
- Department of Oral Pathology Faculty of Dental Medicine, Al Azhar University, Cairo, Egypt
| | - Mohamed H Salama
- Department of Periodontology, Faculty of Dental Medicine, Al Azhar University, Cairo, Egypt
| | - Mahmoud T El Destawy
- Department of Periodontology, Faculty of Dental Medicine, Al Azhar University, Cairo, Egypt
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Issa DR, Abdel-Ghaffar KA, Al-Shahat MA, Hassan AAA, Iacono VJ, Gamal AY. Guided tissue regeneration of intrabony defects with perforated barrier membranes, simvastatin, and EDTA root surface modification: A clinical and biochemical study. J Periodontal Res 2019; 55:85-95. [PMID: 31448832 DOI: 10.1111/jre.12692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 07/08/2019] [Accepted: 07/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM. METHODS Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30. RESULTS At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3. CONCLUSION The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.
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Affiliation(s)
- Dalia Rasheed Issa
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Kafrelsheikh University, Kafr El Sheikh, Egypt
| | - Khaled A Abdel-Ghaffar
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A Al-Shahat
- Department of Periodontology, Faculty of Dental Medicine, Delta University for science and technology, Cairo, Egypt
| | - Ahmed Abdel Aziz Hassan
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - Vincent J Iacono
- School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ahmed Y Gamal
- Department of Periodontology, Faculty of Oral and Dental Medicine, Nahda University, Benisweif, Egypt
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Sterrett JD, Marks M, Dunlap J, Swann J, Dunn M. The effect varied scanning electron microscopy desiccation techniques has on demineralized dentin. Microsc Res Tech 2019; 82:1249-1255. [PMID: 30974017 DOI: 10.1002/jemt.23274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/01/2019] [Accepted: 03/25/2019] [Indexed: 11/09/2022]
Abstract
The study objective was to assess (a) the effect of a rubbing-application of ethylenediaminetetraacetic acid (EDTA) or citric acid (CA) has on the ultrastructure of surface dentin and (b) the effect of two scanning electron microscopy (SEM) desiccation preparation techniques have on the collagen surface produced. Treatment regions on proximal root surfaces of extracted human teeth were root planned to expose dentin. Cotton pellets soaked in either 30% CA or 24% EDTA solution were rubbed on the treatment region then processed for SEM using one of two desiccation techniques, that is, (a) critically point dried from liquid CO2 (control) or (b) air-dried from tetramethylsilane (experimental). Specimens were coated with gold/palladium and viewed/photographed with an SEM. Specimens of the control groups displayed tufted fibrils (CA > EDTA) with many dentin tubules being partially obscured by overhanging fibrils. Air-dried specimens of both treatment groups displayed a flat intact monolayer devoid of a matted meshwork of fibrous collagen. Discrete fibril "sprigs," emanating from the surface monolayer, were characteristic of the EDTA group only. The rubbing-application of EDTA on dentin produces a tufted fibril surface somewhat similar to that produced by CA. Air-drying desiccation of both resulted in marked distortion with fibril collapse/coalescence of the tufted collagen matrix.
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Affiliation(s)
- John D Sterrett
- Department of General Dentistry, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Murray Marks
- Department of General Dentistry, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - John Dunlap
- Advanced Microscopy and Imaging Center, University of Tennessee, Knoxville, Tennessee
| | - Jerilyn Swann
- Department of Biology, Maryville College, Maryville, Tennessee
| | - Montana Dunn
- Department of Biology, Maryville College, Maryville, Tennessee
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Turk T, Kaval ME, Sarikanat M, Hülsmann M. Effect of final irrigation procedures on fracture resistance of root filled teeth: an ex vivo study. Int Endod J 2016; 50:799-804. [PMID: 27464713 DOI: 10.1111/iej.12680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the effect of chlorhexidine (CHX) on fracture resistance of roots treated with different concentrations of ethylenediaminetetraacetic acid (EDTA). METHODOLOGY One hundred and twenty intact single-rooted premolar teeth were sectioned below the cementum-enamel junction to standardize the length of the teeth to 12 mm. The canals of one hundred specimens were instrumented with ProTaper Universal rotary instruments up to size F4 and were randomly divided into five groups (n = 20) according to the final irrigating solutions: Group 1: distilled water (DW); Group 2: 5% EDTA and 2.5% NaOCl; Group 3: 17% EDTA and 2.5% NaOCl; Group 4: 5% EDTA, 2.5% NaOCl, DW and 2% CHX; Group 5: 17% EDTA and 2.5% NaOCl, DW and 2% CHX. Root canals were filled with gutta-percha and epoxy resin-based root canal sealer using a single-cone technique. Twenty teeth served as negative controls and were not instrumented nor root filled (Group 6). All specimens were embedded in self-curing acrylic resin and loaded vertically at 0.5 mm min-1 until fracture occurred. The data were evaluated statistically using one-way anova test followed by Holm-Sidak's multiple comparison test (P < 0.05). RESULTS Group 1 (only DW) had the lowest vertical fracture strength, followed by Group 3 (17% EDTA and 2.5% NaOCl; P < 0.05). Group 6 (negative control group) had the highest fracture resistance. Final irrigation with CHX following irrigation with 17% EDTA or 5% EDTA and 2.5% NaOCl (groups 4 and 5) significantly increased the fracture resistance of roots (P < 0.05). However, the difference between Group 4 and Group 5 was not significant (P > 0.05). CONCLUSIONS Intracanal CHX rinse of EDTA/NaOCl-treated root dentine enhanced the fracture resistance of roots filled with AH Plus.
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Affiliation(s)
- T Turk
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - M E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - M Sarikanat
- Department of Mechanical Engineering, School of Engineering, Ege University, Izmir, Turkey
| | - M Hülsmann
- Department of Operative Dentistry, Periodontology and Cariology, School of Dentistry, University of Göttingen, Göttingen, Germany
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Böttcher DE, Sehnem NT, Montagner F, Fatturi Parolo CC, Grecca FS. Evaluation of the Effect of Enterococcus faecalis Biofilm on the 2% Chlorhexidine Substantivity: An In Vitro Study. J Endod 2015; 41:1364-70. [PMID: 26025346 DOI: 10.1016/j.joen.2015.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to correlate the bacterial viability and the presence of 2% chlorhexidine (CHX) solution on dentin by means of confocal laser scanning microscopy and high-performance liquid chromatography for 48 hours, 7 days, and 30 days. METHODS One hundred twenty-three extracted human teeth were used. Samples were divided into 4 groups according to the solution (CHX or saline) and the presence of Enterococus faecalis biofilm. Samples were kept in contact with 5 mL of the solution for 5 minutes. Each group was divided into 3 subgroups according to the evaluation period (n = 10). Statistical analysis was performed by using the Kruskal-Wallis test, the Mann-Whitney U test (P < .05), and the Spearman rank correlation coefficient (P < .01). RESULTS There was a negative correlation between the percentage of live cells and the amount of remaining CHX (P = .000). CHX significantly reduced the percentage of viable cells compared with saline after 48 hours (P = .007). Differences were maintained in the 7-day evaluation period (P = .001). After 30 days, the CHX group presented an increase of viable cells, thereby becoming similar to saline (P = .623). Simultaneously, the remaining CHX was significantly reduced in the 30-day specimens (P = .000). CONCLUSIONS The results of this study indicate that 2% CHX solution was detected for 48 hours and 7 days with a low percentage of viable cells. The presence of microorganisms on human dentin did not affect 2% CHX maintenance.
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Affiliation(s)
- Daiana Elisabeth Böttcher
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Nicole T Sehnem
- Biotechnology and Biochemical Engineering Laboratory (BiotecLab), School of Food Engineering, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Francisco Montagner
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Clarissa Cavalcanti Fatturi Parolo
- Social and Preventive Dentistry Department, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabiana Soares Grecca
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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Ghandi M, Houshmand B, Nekoofar MH, Tabor RK, Yadeghari Z, Dummer PMH. The effect of MTAD, an endodontic irrigant, on fibroblast attachment to periodontally affected root surfaces: A SEM analysis. J Indian Soc Periodontol 2013; 17:188-92. [PMID: 23869124 PMCID: PMC3713749 DOI: 10.4103/0972-124x.113067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 08/17/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Root surface debridement (RSD) is necessary to create an environment suitable for reattachment of the periodontium. Root surface conditioning may aid the formation of a biocompatible surface suitable for cell reattachment. BioPure™ MTAD (mixture of Doxycycline, citric acid and a detergent) is an endodontic irrigant with antibacterial properties and the ability to remove smear layer. It was hypothesized that MTAD may be useful for root surface conditioning. The efficacy of MTAD as a conditioner was measured by examining fibroblast attachment to root surfaces. MATERIALS AND METHODS Thirty-two specimens of human teeth with advanced periodontal disease were used. The surfaces were root planed until smooth. Half of the specimens were treated with 0.9% saline and the other samples with Biopure MTAD. As a negative control group, five further samples were left unscaled with surface calculus. Human gingival fibroblast cells HGF1-PI1 were cultured and poured over the tooth specimens and incubated. After fixation, the samples were sputter-coated with gold and examined with a SEM. The morphology and number of attached, fixed viable cells were examined. The data was analysed using the Mann-Whitney-U statistical test. RESULTS There was no significant difference between the numbers of attached cells in the experimental group treated with MTAD and the control group treated with saline. Little or no attached cells were seen in the negative control group. CONCLUSION RSD created an environment suitable for cell growth and attachment in a laboratory setting. The use of MTAD did not promote the attachment and growth of cells on the surface of human roots following RSD.
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Affiliation(s)
- Mostafa Ghandi
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gamal AY, Kumper RM, Al Gendy AERR. Doxycycline-Loaded β-Tricalcium Phosphate Release Following EDTA Root Surface Etching Improved the Clinical Outcomes in Chronic Periodontitis: An In Vivo Study. J Periodontol 2013; 84:924-33. [DOI: 10.1902/jop.2012.120343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gamal AY, Iacono VJ. Mixed nano/micro-sized calcium phosphate composite and EDTA root surface etching improve availability of graft material in intrabony defects: an in vivo scanning electron microscopy evaluation. J Periodontol 2013; 84:1730-9. [PMID: 23451990 DOI: 10.1902/jop.2013.120701] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of nanoparticles of graft materials may lead to breakthrough applications for periodontal regeneration. However, due to their small particle size, nanoparticles may be eliminated from periodontal defects by phagocytosis. In an attempt to improve nanoparticle retention in periodontal defects, the present in vivo study uses scanning electron microscopy (SEM) to evaluate the potential of micrograft particles of β-tricalcium phosphate (β-TCP) to enhance the binding and retention of nanoparticles of hydroxyapatite (nHA) on EDTA-treated and non-treated root surfaces in periodontal defects after 14 days of healing. METHODS Sixty patients having at least two hopeless periodontally affected teeth designated for extraction were randomly divided into four treatment groups (15 patients per group). Patients in group 1 had selected periodontal intrabony defects grafted with nHA of particle size 10 to 100 nm. Patients in group 2 were treated in a similar manner but had the affected roots etched for 2 minutes with a neutral 24% EDTA gel before grafting of the associated vertical defects with nHA. Patients in group 3 had the selected intrabony defects grafted with a composite graft consisting of equal volumes of nHA and β-TCP (particle size 63 to 150 nm). Patients in group 4 were treated as in group 3 but the affected roots were etched with neutral 24% EDTA as in group 2. For each of the four groups, one tooth was extracted immediately, and the second tooth was extracted after 14 days of healing for SEM evaluation. RESULTS Fourteen days after surgery, all group 1 samples were devoid of any nanoparticles adherent to the root surfaces. Group 2 showed root surface areas 44.7% covered by a single layer of clot-blended grafted particles 14 days following graft application. After 14 days, group 3 samples appeared to retain fibrin strands devoid of grafted particles. Immediately extracted root samples of group 4 had adherent graft particles that covered a considerable area of the root surfaces (88.6%). Grafted particles appeared to cover all samples in a multilayered pattern. After 14 days, the group 4 extracted samples showed multilayered fibrin-covered nano/micro-sized graft particles adherent to the root surfaces (78.5%). CONCLUSION The use of a composite graft consisting of nHA and microsized β-TCP after root surface treatment with 24% EDTA may be a suitable method to improve nHA retention in periodontal defects with subsequent graft bioreactivity.
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Affiliation(s)
- Ahmed Y Gamal
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
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Gamal AY, Kumper RM. A Novel Approach to the Use of Doxycycline-Loaded Biodegradable Membrane and EDTA Root Surface Etching in Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2012; 83:1086-94. [DOI: 10.1902/jop.2011.110476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gamal AY. Enhanced β-Tricalcium Phosphate Blended Clot Adhesion to EDTA Biomodulated Periodontally Affected Root Surfaces: In Vivo Scanning Electron Microscopy Evaluation. J Periodontol 2011; 82:1587-95. [DOI: 10.1902/jop.2011.110023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aspriello SD, Piemontese M, Levrini L, Sauro S. Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study. J Appl Oral Sci 2011; 19:74-81. [PMID: 21437474 PMCID: PMC4245868 DOI: 10.1590/s1678-77572011000100015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 10/22/2009] [Indexed: 11/22/2022] Open
Abstract
Objective The purpose of this study was to investigate the ultramorphology of the root surfaces
induced by mechanical instrumentation performed using conventional curettes or
piezoelectric scalers when used single-handedly or with a combined technique. Material and Methods Thirty single-rooted teeth were selected and divided into 3 groups: Group A,
instrumentation with curettes; Group B instrumentation with titanium nitride coated
periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with
curette/ultrasonic piezoelectric instrumentation. The specimens were processed and
analyzed using confocal and scanning electron microscopy. Differences between the
different groups of instrumentation were determined using Pearson’s χ
2 with significance predetermined at α=0.001. Results Periodontal scaling and root planing performed with curettes, ultrasonic or combined
instrumentation induced several morphological changes on the root surface. The curettes
produced a compact and thick multilayered smear layer, while the morphology of the root
surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a
thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed
root dentin tubules with a surface morphology characterized by the presence of very few
grooves and slender remnants of smear layer which only partially covered the root
dentin. In some cases, it was also possible to observe areas with exposed collagen
fibrils. Conclusion The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects
of each instrument in a single technique creating a root surface relatively free from
the physical barrier of smear layer and dentin tubules orifices partial occlusion.
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Affiliation(s)
- Simone D Aspriello
- Institute of Dental Science, Division of Periodontology, Polytechnic University of Marche, Ancona, Italy
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Gamal AY, Kumper RM, Sadek HS, El Destawy MT. Chlorhexidine Controlled-Release Profile After EDTA Root Surface Etching: An In Vivo Study. J Periodontol 2011; 82:751-7. [DOI: 10.1902/jop.2010.100523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aspriello SD, Zizzi A, Spazzafumo L, Rubini C, Lorenzi T, Marzioni D, Bullon P, Piemontese M. Effects of enamel matrix derivative on vascular endothelial growth factor expression and microvessel density in gingival tissues of periodontal pocket: a comparative study. J Periodontol 2010; 82:606-12. [PMID: 20843235 DOI: 10.1902/jop.2010.100180] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) stimulates proliferation and migration of endothelial cells, and correlates with inflammatory resolution and periodontal tissue healing. Enamel matrix derivative (EMD) seems to stimulate soft tissue healing. Our aim was to assess if topical EMD application in an instrumented periodontal pocket could affect angiogenesis at the gingival level. METHODS A total of 56 periodontal sites in 28 patients were treated with a single session of comprehensive scaling and root planing under local anesthesia after recording the clinical attachment level (CAL). EMD gel in the test site or only the vehicle propylene glycol alginate in aqueous solution in the control site of the same mouth was applied onto the root surfaces and into the pocket and left in place for 3 minutes. After 48 hours, gingival biopsies were collected for histologic and immunohistochemical analysis for VEGF and CD34 (for microvessel density [MVD] count) antibodies. Statistical comparisons were performed by analysis of variance test. RESULTS Endothelial VEGF expression and MVD were statistically different in the test site compared to the control site. VEGF expression and MVD of the control site were not correlated with CAL, whereas the test site showed high correlations among CAL and endothelial VEGF or MVD. CONCLUSIONS EMD induces proliferation and viability and angiogenesis of human microvascular cells. Recent clinical and histologic studies found EMD to be useful as an adjunct to scaling and root planing in single-rooted teeth. Our findings may help to understand the mechanisms involved in soft tissue healing, through the ability of EMD to increase angiogenesis at periodontal pockets.
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Affiliation(s)
- Simone Domenico Aspriello
- Department of Clinical Specialistic and Dental Sciences - Periodontology, Polytechnic University of Marche, Torrette, Ancona, Italy.
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